Dynamics of serum α-fetoprotein in viral hepatitis C without hepatocellular carcinoma
Teodora Isac1, Sebastian Isac2, Simona Ioanitescu1
1Department of Internal Medicine II, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Insights
Serum alpha-fetoprotein (AFP) can be moderately elevated in chronic hepatitis C patients without liver cancer. Elevated AFP correlates with liver damage markers and fibrosis, regardless of viral load or treatment response.
Area of Science:
- Hepatology
- Virology
- Clinical Biochemistry
Background:
- Viral hepatitis C (HCV) is a major global health concern impacting liver health and healthcare systems.
- Hepatocellular carcinoma (HCC) is a known complication of chronic HCV, often associated with elevated alpha-fetoprotein (AFP).
- Understanding non-cancer-related markers in HCV is crucial for accurate patient management.
Purpose of the Study:
- To investigate serum alpha-fetoprotein (AFP) levels in chronic hepatitis C patients without HCC.
- To correlate AFP levels with prognostic tools like Fibroscan®, mixed cryoglobulinemia, and biochemical markers.
- To assess the relationship between AFP, liver damage, and fibrosis in HCV patients.
Main Methods:
- A clinical study involving three groups: chronic HCV patients (HCV group, n=35), patients achieving sustained viral response (SVR group, n=20), and healthy controls (n=37).
- Serum AFP levels were measured and correlated with Fibroscan® (liver stiffness), mixed cryoglobulinemia, aspartate transaminase (AST), alkaline phosphatase (AP), and γ-glutamyl transferase (GGT).
- Demographic and standard biochemical markers were analyzed.
Main Results:
- Serum AFP was moderately elevated in both HCV and SVR groups compared to controls.
- AFP showed a positive correlation with AST, AP, and GGT, indicating a link to hepatic cytolysis and cholestasis.
- Mixed cryoglobulinemia was more frequent in the HCV group. Fibroscan® indicated increased fibrosis in both HCV and SVR groups, with no significant reversibility post-therapy.
Conclusions:
- Moderate AFP elevation can occur in chronic hepatitis C patients even without HCC, independent of viral load or treatment success.
- Serum AFP levels correlate positively with the degree of liver damage (cytolysis and cholestasis).
- While mixed cryoglobulinemia decreases after successful HCV therapy, liver fibrosis may not significantly reverse within 12 weeks.
Abstract:
Viral hepatitis C represents a significant liver pathology worldwide, with a detrimental impact on national health systems. The present study aimed to correlate the levels of serum α-fetoprotein (AFP) with prognostic tools such as Fibroscan®, the presence of mixed cryoglobulinemia, and various demographic and standard biochemical markers, in patients with chronic hepatitis C, unrelated to hepatocellular carcinoma (HCC). A clinical study was designed considering three study groups: Hepatitis C virus (HCV) group including 35 patients with chronic hepatitis C and detectible viral load; sustained viral response (SVR) group including 20 HCV patients without detectable virus load 12 weeks after therapy cessation; a control group represented by 37 healthy volunteers. It was observed that serum AFP was moderately increased in the HCV and SVR groups and was positively correlated with aspartate transaminase (AST), alkaline phosphatase (AP), and γ-glutamyl transferase (GGT). The incidence of mixed cryoglobulinemia was increased in the HCV group, and the degree of fibrosis assessed by Fibroscan® was increased in both the HCV and SVR groups. In conclusion, the data revealed that a moderate increase in AFP levels could be present in patients with HCV even in the absence of HCC, unrelated to viral load or therapy response and that there was a linear positive correlation between serum levels of AFP and the degree of hepatic cytolysis and cholestasis. Additionally, mixed cryoglobulinemia was present in HCV patients with patent viral load, decreasing in those with SVR after therapy cessation unrelated to any renal impairment, while the degree of fibrosis was increased in HCV-infected patients, with no reversibility 12 weeks after successful therapy.
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